Different Modes of Treatment for Systolic Heart Failure Essay

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Three types of device have proven safe and effective for treatment of systolic heart failure:
(1) atrial-synchronised biventricular pacing (also called cardiac resynchronisation therapy);
(2) Implantable cardioverter defibrillators; and
(3) In highly selected patients, left-ventricular assist devices.

9.1- Cardiac resynchronisation therapy (CRT)

The rationale for cardiac resynchronisation therapy is based on the presence of ventricular dyssynchrony, which is currently defined as a QRS duration of at least 120 ms on the surface ECG. Dyssynchrony can arise between the left and right ventricles and within the left ventricle, impairing the ability of the heart to function as a pump. This disorder can be improved by biventricular
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At present, patients with left ventricular ejection fraction less than or equal to 35%, normal sinus rhythm, and New York Heart Association (NYHA) functional class III or ambulatory class IV symptoms despite best medical treatment who have ventricular dyssynchrony should receive cardiac resynchronisation therapy, unless contraindicated. Few contraindications to this method exist but could include comorbidity expected to limit the success of the procedure and excessive risk in patients who are too ill to undergo device implantation.

9.2- Implantable cardioverter defibrillators(Figure 1) Figure 1- Implantable cardioverter defibrillators

Implantable cardioverter defibrillators were initially given to survivors of sudden cardiac death to treat recurrent episodes of ventricular tachycardia or ventricular fibrillation. People with left-ventricular dysfunction, either from ischaemic or non-ischaemic causes, are at increased risk for sudden cardiac death.10, 11
Thus, the notion that implantable cardioverter defibrillators might be useful for primary prevention of sudden cardiac death in heart failure

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